下腔静脉滤器在中风患者中的长期安全性和有效性。
Long-term safety and effectiveness of inferior vena cava filters in patients with stroke.
机构信息
Department of Imaging, Massachusetts General Hospital, Boston, MA, USA.
出版信息
J Neurointerv Surg. 2011 Jun;3(2):141-6. doi: 10.1136/jnis.2010.004564. Epub 2011 Jan 30.
PURPOSE
To assess the long-term safety and clinical effectiveness of inferior vena cava (IVC) filters in patients with stroke.
METHOD AND MATERIALS
In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study, we reviewed the clinical data of patients who had stroke and were treated with an IVC filter from 2002 to 2009. The demographics, clinical data, indications for IVC filter, procedural complications, symptomatic post-filter pulmonary embolism (PE) and deep vein thrombosis (DVT), caval occlusion and incidental, imaging-evident filter-related complications were recorded. Safety was assessed through occurrence of filter-related complications during placement and follow-up. Effectiveness was assessed through occurrence of post-filter fatal and non-fatal PE.
RESULTS
During this period, 371 patients (224 male; mean age 67.5 years) with stroke received an IVC filter. The stroke was hemorrhagic in 28%, ischemic in 20%, associated with intracranial malignancy in 21% and trauma in 31%. 235 (63%) patients (PE in 159) had venous thromboembolism on imaging. The indications for IVC filter included contraindication to anticoagulation in 251 (68%), prophylaxis in 83 (22%), added protection in 22 (6%) and complication or failure of anticoagulation in 15 (4%). There was one procedural complication. During a follow-up of 1.74±2.36 years, 180 (49%) patients died, three due to post-filter PE and the remainder all due to primary disease. Symptomatic post-filter PE and DVT occurred at a frequency of 15% (54/371) and 16% (60/371), respectively. Of these, 15 (4%) had imaging-proven PE. Three (0.8%) succumbed to post-filter PE. Imaging-proven new or recurrent DVT occurred in 6% and 8%, respectively. Symptomatic caval occlusion was seen in five (5/371, 1.3%).
CONCLUSION
IVC filters have an acceptable safety profile in stroke patients. In our cohort, they were effective in preventing life-threatening PE.
目的
评估下腔静脉（IVC）滤器在中风患者中的长期安全性和临床疗效。
方法和材料
在这项经机构审查委员会批准、符合《健康保险流通与责任法案》的回顾性研究中，我们回顾了 2002 年至 2009 年间接受 IVC 滤器治疗的中风患者的临床数据。记录了患者的人口统计学、临床数据、IVC 滤器的适应证、程序并发症、滤器后症状性肺栓塞（PE）和深静脉血栓形成（DVT）、腔静脉闭塞和偶然发现的、影像学证实的滤器相关并发症。安全性通过滤器放置和随访期间发生的滤器相关并发症来评估。有效性通过滤器后致命和非致命性 PE 的发生来评估。
结果
在此期间，371 名中风患者（224 名男性；平均年龄 67.5 岁）接受了 IVC 滤器。中风患者中 28%为出血性、20%为缺血性、21%与颅内恶性肿瘤相关、31%为创伤性。235 名（63%）患者（159 例有 PE）在影像学上有静脉血栓栓塞。IVC 滤器的适应证包括抗凝禁忌 251 例（68%）、预防 83 例（22%）、附加保护 22 例（6%）和抗凝并发症或失败 15 例（4%）。有 1 例程序并发症。在 1.74±2.36 年的随访期间，180 名（49%）患者死亡，3 例死于滤器后 PE，其余均死于原发疾病。症状性滤器后 PE 和 DVT 的发生率分别为 15%（54/371）和 16%（60/371），其中 15 例（4%）有影像学证实的 PE。3 例（0.8%）死于滤器后 PE。影像学证实的新发或复发性 DVT 分别为 6%和 8%。症状性腔静脉闭塞发生在 5 例（5/371，1.3%）患者中。
结论
IVC 滤器在中风患者中具有可接受的安全性。在我们的队列中，它们在预防危及生命的 PE 方面是有效的。
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